Application for Leadership Gwinnett Scholarship

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email*

Phone*

Who is ultimately responsible for covering your tuition costs?*

My employer will either pay or reimburse me for the entire tuition.
My employer will either pay or reimburse me for a portion of the tuition.
An organization other than my employer will either pay or reimburse for all or a portion of the tuition.
I am personally responsible for the entire tuition.

Are you requesting a scholarship?*

Yes
No

What other sources are you pursuing for financial assistance?*

Please indicate the total amount you are requesting.*

We do not grant full scholarships, but we would like to enable your participation.

Give no more than three compelling reasons why you should be awarded a partial scholarship.*

Will you be able to participate in the program if your scholarship request is not granted?*

Yes
No

If you are granted a partial scholarship, will you be able to provide the remaining funds for tuition?*

Yes
No

What are your major job responsibilities?*

How are you currently engaged in the Gwinnett community?*

Why would you like to participate in Leadership Gwinnett and how will you use this experience to positively impact the community and your organization?*

Terms & Conditions*

1. Tuition is non-refundable. In the event you are unable to complete the Leadership Gwinnett program and graduate or are dismissed from the program, you agree to refund 100% of the scholarship funds awarded back to the Leadership Gwinnett Foundation within 30 days.

2. For scholarship applicants only -- partial scholarships awarded are an advance and those receiving are asked to pledge at least $150 annually to the Leadership Gwinnett Foundation following graduation so that other worthy applicants can benefit from scholarship dollars.

Check this box to certify you have read and understand the terms and conditions.